The Government's National Child Measurement Programme (NCMP) in schools, an intervention designed to tackle childhood obesity, "may be at risk of harming the children it aims to help", according to new research from Queen Mary University of London.
The NCMP records the height and weight of school children in England, with the aim of gathering data "to understand long-term trends in childhood obesity and inform national and local initiatives". It is unique to England, covers the majority of primary-school aged children and, according to NHS Digital, aims to be "a vehicle for engaging with children and families about healthy lifestyles and weight issues". However, the researchers said that the current programme may be "doing more harm than good".
Under the programme, children of primary school age are weighed and measured at school by visiting health professionals. Their body mass index (BMI) is calculated, and the results are issued to parents to advise whether their child has been categorised as 'underweight', a 'healthy weight', 'overweight' or 'very overweight'.
The study, published in Critical Public Health, is the first to look at the experiences of parents and their children who were categorised as 'overweight' or 'very overweight' by the NCMP.
Potential Mental Health Harms
The researchers collated and examined published research on the programme and showed that these children's families "expressed significant concerns about the potential for harmful effects on their child's mental health".
Parents of children categorised as overweight often indicated that they felt judged, blamed, and criticised for their parenting performance when they received the results letter. Many parents came "to resist and reframe the programme and its results, to protect their children from a weight-focused future", the team said.
They noted that taking part in the programme was "an emotionally significant moment for many children who were told they were above a healthy weight" and “marked a turning point in the child’s awareness of body weight; altering their relationship with food and changing how they related to peers".
Children reported feeling anxiety and embarrassment about the weighing process, the result, and the potential for weight-related teasing. While some parents dismissed the result, many expressed concern that the potential for mental health disorders, eating disorders and unhealthy dieting behaviours in the future was "far more dangerous than the weight itself", and said that their priority was the child's happiness.
The team commented that: "These concerns are not unfounded – the study cites an analysis of the impact of weight-related conversations on children, which found that being encouraged to lose weight, teasing, and weight-related criticism were associated with poorer self-perceptions, increased dieting, and dysfunctional eating behaviours."
They noted other research showing a significant rise in reported weight loss attempts amongst children, including those considered 'healthy weight', following the introduction of the NCMP letter in 2010-11.
'Central Paradox' of the Programme
The researchers highlighted what they considered "a central paradox" of the programme and the attempts to use NCMP monitoring to (re)shape lives at the individual and social level: "The children it sets out to help are the most likely to experience harm as a result of it."
They added that further research is needed to understand whether parents' concerns are being borne out in the long term, and that it is important to find ways "to mitigate any negative effects of the programme". Policymakers need to thoroughly consider the questions that their findings raise, they stressed: "Is the National Child Measurement Programme in its current form causing some children harm, how can this be mitigated, and how does it balance against the positive use of the data the programme produces?"
The latest criticism comes on top of disparagement last year that labelled the Government's 'Tackling Obesity' campaign as "wilful political strategy", with commentators calling it "unproductive", "ineffective", and "irresponsible", adding that it could lead to 'fat-shaming'.
In some areas of England, efforts have been made to change the wording of the NCMP results letters issued to families; for example, to avoid using 'stigmatising' words like 'overweight' and 'obese'. But these measures are locally driven and vary across the country, the authors pointed out.
Increasing Child Obesity Levels
The latest child obesity statistics gathered as part of the NCMP and published last month, showed that 10.1% of reception age children (age 4-5) were classed as obese in 2021/22, with a further 12.1% classed as overweight. At age 10-11 (year 6), 23.4% were obese and 14.3% overweight. The authors of the new study noted that childhood obesity levels were "high, increasing, and strongly linked to child poverty".
Lead author Dr Meredith K.D. Hawking, a research fellow at Queen Mary University of London, said: "Many parents have legitimate concerns about the impact the National Child Measurement Programme might have on children’s self-perception and food practices as they grow older. More research is needed to understand whether these concerns are borne out in the long term and to find ways to mitigate them if the programme is to continue."
The authors said: "The NCMP generates valuable insights but it requires policy and actions – beyond those which can be taken by families acting alone – to halt and reverse the rising proportion of children who are an unhealthy weight."
They added: "There is little evidence that initiatives to change the behaviour of individual families are successful in reducing childhood obesity at a population level. Policy approaches to tackling obesity, including the soft drinks industry levy, and extending eligibility for free school meals as recommended in the National Food Strategy independent review, may be much more ethical and effective."
Dr Hawkin added: "To improve child health, the Government must act on the evidence the NCMP and other sources are producing. We know that childhood obesity is a strong indicator of child poverty. Without meaningful regulation of the food industry or measures to address poverty, parents will be unsupported in their efforts to help children live healthier lives."
It's Not Easy to Eat Healthily
Asked to comment on the study by Medscape News UK, Katharine Jenner, director of the Obesity Health Alliance, said: "It should be easy for everyone to eat healthily, especially children. It isn’t. The invaluable data gained from the National Child Measurement Programme is being used to design ways of tackling the root causes of diet-related ill health, such as the cheap, unhealthy, heavily processed food that is advertised to children day in, day out.
"From a public health perspective, as we found with COVID-19, gathering data for use at a population level is vital to identify the scale of an issue and an appropriate response. This paper repeats some negative views that are held by a sample of parents, which should be considered to help inform how the information gathered may be best used to support children’s physical and mental health."
MH received funding through the Economic and Social Research Council LISS DTP, and Bart's Charity. CD received funding for her research on child obesity from Barts Charity and the UK Prevention Research Partnership, an initiative funded by UK Research and Innovation Councils, the Department of Health and Social Care (England) and the UK devolved administrations, and leading health research charities. DS is funded by the National Institute for Health and Care Research through a Clinician Scientist Award.The authors report there are no competing interests to declare.